Double Dissection With an Aneurysm
19 March, 1997
I am a 53 year old never smoking male who until the trauma was a regular gym attender and walker with no known health problems. On Monday morning the 14 October 1996 I woke to experience intense chest pain which I believed was a torn chest muscle. The local doctor was convinced that it was a heart related problem although the pain had subsided and referred me to a cardiologist after prescribing angina tablets to relieve the pain which subsided during the day.
By evening I was able to attend a meeting in a non active mode and next day went to work as usual. Mid afternoon, I became aware of a sense of weakness and was driven home early. Attendance at the doctor's surgery produced instant action and an ambulance ride to hospital. Apart from weakness, the only symptom was asymmetric blood pressure observed by the paramedics during the ambulance ride.
The hospital was initially convinced that I was suffering from severe gastritis but after X-rays and a CAT scan, I was told that two dissections of the ascending aorta were visible. One was probably historic and had self healed! The current dissection was producing an aneurism which was distorting valve function and was likely to produce coronary artery compression. The other was responsible for the aneurism. (This cured dissection may have occurred 2 years prior when chest pain gave me an ambulance ride to hospital where blood tests and ECG showed no problems).
A sudden drop in blood pressure saw me wheeled in to emergency surgery and a St Jude's valve along with section of dacron inserted. Intensive care was most difficult as with some lung fluid, the intensive care specialist insisted on nitric oxide loaded oxygen (if he had read his texts he would have realized it was nitrogen peroxide as it oxidizes). After 24 hours on forced ventilation I remained in intensive care for a total of 8 days. For most of this period I was fully conscious and aware. A chamber of horrors.
Within two days of transfer to a normal cardiac ward, the effect of a painless surgical trauma induced gastric ulcer produced extreme weakness from loss of blood. This was quickly remedied by endoscopic application of adrenalin and 6 units of blood. Recovery preceded apace after that and I was finally sent home on November 5 almost 3 weeks after admission.
Prior to starting the rehabilitation program two weeks after release, I started walking in addition to continuing the exercise series given in hospital. Wearing of a heart rate monitor was very useful as it helped me to monitor and therefore limit heart rate. I have returned to gym activities with an emphasis now on cardiovascular exercises with the blessing of my cardiologist.
Apart from the clacking of the aortic valve and the necessity to take warfarin to increase clotting time and Sotalol to work some kind of effect on my heart, I feel only minor discomfort from time to time. I still feel grateful that I am alive, especially after reading some of the material on the net. Information on long term prospects seems remarkably scarce for those surgically "cured" of an aortic aneurism. It also surprises me that it is not routine to check with MRI that the problem has been "cured" and to ensure that no other aneurysms are present in other regions of the aorta.
I would like to manage contact with others who have had a similar experience.
Update 9 Apr 1999
A few months after travelling to the US and UK in late 1997 I found exercise difficult and believing it was the effect of sotalol I consulted physician and cardiologist. While being prepared for an angiogram in hospital a blood test revealed a red cell count down to 50% of normal. On endoscopic examination this turned out to be a very small colon cancer which was removed. After an unpleasant recovery I was placed on 6 months chemotherapy as the colon cancer was Dukes type C and present in 6 of 14 lymph nodes. The chemotherapy played havoc with warfarin dose rates and weekly INR checks became order of the day. My current stabilised INR is now around 2.4 and is maintained by 6.5mg warfarin as opposed to 8mg previously. I think I'm OK but the combination of colon cancer and aneurism is somewhat frightening. When a fresh CT scan was taken I asked for it to include the ascending arch. This revealed the dissection still in existence and extending to the diaphragm. A false lumen open at both ends was also present. I have been assured that there is no cause for concern.
Discussion, comments, or questions: Peter Wilsen
© Copyright 1997 Peter Wilsen